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Grundlagen der Embolisation und anderer verschließender Verfahren

Embolotherapy: principles and indications

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Zusammenfassung

Interventionell-radiologische verschließende Verfahren sind hinsichtlich Indikationsstellung, Materialwahl und technischem Vorgehen differenzierte und komplexe Prozeduren. In vielen klinischen Konstellationen stellen sie eine minimalinvasive Alternative zur Operation oder einen wichtigen Bestandteil eines multimodalen Therapiekonzepts dar. Blutungen, Gefäßmalformationen und Tumoren sind die wichtigsten Erkrankungsgruppen, bei denen verschließende Prozeduren, v. a. die Embolisation, effektiv eingesetzt werden. Für Letztere stehen neben speziellen Kathetern differenzierte Materialien zur Verfügung. Je nach gewünschter Verschlussebene und individueller Gefäßsituation werden mechanische, partikuläre und flüssige Embolisate eingesetzt. Sklerosierungssubstanzen und Thrombin sind Spezialindikationen vorbehalten. Interdisziplinäre Entscheidungs- und Behandlungsstrukturen sowie intensive Erfahrung des interventionellen Teams sind Voraussetzung für einen erfolgreichen Einsatz verschließender Verfahren.

Abstract

Vascular embolizations are complex and sophisticated procedures and can be a powerful alternative or useful adjunct to surgery in many clinical situations. Hemorrhage, vascular malformations, and tumors are the main indications for embolization procedures. Establishing the correct indication for intervention as well as the proper embolic agent and the most suitable catheterization technique requires advanced knowledge in interventional radiology, and an interdisciplinary approach is a prerequisite. A broad spectrum of microcatheters and embolization materials is available for these therapies. The desired level of occlusion and the individual vascular territory determine the choice of mechanical devices, particles, or liquid substances. Sclerosing agents and thrombin are used in special situations such as varicoceles and pseudoaneurysms.

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Literatur

  1. Antonitsis P, Saratzis N, Velissaris I et al. (2006) Management of cervical paragangliomas: review of a 15-year experience. Langenbecks Arch Surg 391: 396–402

    Article  PubMed  Google Scholar 

  2. Barth KH (2006) In: Baum S, Pentecost MJ (eds) Abram’s angiography – interventional radiology. Lippincott Williams & Wilkins, Philadelphia, pp 1–18

  3. Baum RA, Stavropoulos SW, Fairman RM et al. (2003) Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 14: 1111–1117

    PubMed  Google Scholar 

  4. Benson DA, Stockinger ZT, McSwain NE (2005) Embolization of an acute renal arteriovenous fistula following a stab wound: case report and review of the literature. Am Surg 71: 62–65

    PubMed  Google Scholar 

  5. Berenstein A, Lasjaunias P, Choi IS (1993) Endovascular treatment of arteriovenous malformations of the brain. In: Valavanis A (ed) Interventional neuroradiology. Springer, Berlin Heidelberg New York

  6. Cornud F, Belin X, Amar E et al. (1999) Varicocele: strategies in diagnosis and treatment. Eur Radiol 9: 536–545

    Article  PubMed  CAS  Google Scholar 

  7. Del Poggio P, Maddeo A, Zabbialini G et al. (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads. J Hepatol 47:157–158

    Article  CAS  Google Scholar 

  8. Ferro C, Rossi UG, Bovio G et al. (2007) Percutaneous transcatheter embolization of a large pulmonary arteriovenous fistula with an Amplatzer vascular plug. Cardiovasc Intervent Radiol 30: 328–331

    Article  PubMed  Google Scholar 

  9. Gabelmann A, Görich J, Merkle EM (2002) Endovascular treatment of visceral artery aneurysms. J Endovasc Ther 9:38–47

    Article  PubMed  Google Scholar 

  10. Gaetje R (2004) Organerhaltende Therapiemöglichkeiten beim Uterus myomatosus. Zentralbl Gynakol 126: 119–124

    Article  PubMed  CAS  Google Scholar 

  11. Garrean S, Muhs A, Bui JT et al. (2007) Complete eradication of hepatic metastasis from colorectal cancer by Yttrium-90 SIRT world. J Gastroenterol 13: 3016–3019

    Google Scholar 

  12. Gates VL, Atassi B, Lewandowski RJ et al. (2007) Radioembolization with Yttrium-90 microspheres: review of an emerging treatment for liver tumors. Future Oncol 3: 73–81

    Article  PubMed  CAS  Google Scholar 

  13. Gelfand DV, White GH, Wilson SE (2006) Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 20: 69–74

    Article  PubMed  Google Scholar 

  14. Ha CD, Calcagno D (2005) Amplatzer vascular plug to oclude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair. J Vasc Surg 42: 1058–1062

    Article  PubMed  Google Scholar 

  15. Huppert PE, Lauchert W, Duda SH et al. (2004) Chemoembolisation des hepatozellulären Karzinoms: Welche Faktoren bestimmen Therapieansprechen und Überleben? Fortschr Röntgenstr 176: 375–385

    Article  CAS  Google Scholar 

  16. Idowu O, Barodawala F, Nemeth A et al. (2007) Dual use of an Amplatzer device in the transcatheter embolization of a large high-flow renal arteriovenous fistula. J Vasc Interv Radiol 18:671–676

    Article  PubMed  Google Scholar 

  17. Kato K, Tomura N, Takahashi S et al. (2006) Balloon occlusion test of the internal carotid artery: correlation with stump pressure and 99mTc-HMPAO SPECT. Acta Radiol 47:1073–1078

    Article  PubMed  CAS  Google Scholar 

  18. Khanna A, Ognibene SJ, Koniaris LG (2005) Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg 9: 343–352

    Article  PubMed  Google Scholar 

  19. Kröncke TJ, David D et al. (2007) Uterusarterienembolisation zur Myombehandlung: Ergebnisse des 2. Radiologisch-gynäkologischen Expertentreffens. Frauenarzt 48: 448–452

    Google Scholar 

  20. Krüger K, Zähringer M, Söhngen FD et al. (2003) Femoral pseudoaneurysms: management with percutaneous thrombin injections – success rates and effects on systemic coagulation. Radiology 226: 452–458

    Article  PubMed  Google Scholar 

  21. Krüger K, Wagner D, Gawenda M et al. (2007) Coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses: success rate and complications. Rofo 179: 587–592.

    PubMed  Google Scholar 

  22. Kuo WT, Lee DE, Saad WE et al. (2003) Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 14:1503–1509

    PubMed  Google Scholar 

  23. Lesurtel M, Mullhaupt B, Pestalozzi BC et al. (2006) Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant 6: 2644–2650

    Article  PubMed  CAS  Google Scholar 

  24. Liapi E, Geschwind JF (2007) Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 25: 978–986

    Article  PubMed  Google Scholar 

  25. Lin YC, Kudelka AP, Lawrence D et al. (1996) Transcatheter arterial embolization for the control of life-threatening pelvic hemorrhage in a patient with locally advanced cervix carcinoma. Eur J Gynaecol Oncol 17: 480–483

    PubMed  CAS  Google Scholar 

  26. Lönn L, Olmarker A, Geterud K et al. (2004) Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. J Endovasc Ther 11: 570–576

    Article  PubMed  Google Scholar 

  27. Madoff DC, Gupta S, Ahrar K et al. (2006) Update on the management of neuroendocrine hepatic metastases. J Vasc Interv Radiol 17: 1235–1249

    PubMed  Google Scholar 

  28. Mansour MA, Gorsuch JM (2007) Diagnosis and management of pseudoaneurysms. Perspect Vasc Surg Endovasc Ther 19: 58–64

    Article  PubMed  Google Scholar 

  29. Marelli L, Stigliano R, Triantos C et al. (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Interv Radiol 30: 6–25

    Article  Google Scholar 

  30. Maxwell NJ, Saleem Amer N, Rogers E et al. (2007) Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol 80: 96–102

    Article  PubMed  CAS  Google Scholar 

  31. Miller MT, Comerota AJ, Disalle R et al. (2007) Endoluminal embolization and revascularization for complicated mesenteric pseudoaneurysms: a report of two cases and a literature review. J Vasc Surg 45: 381–386

    Article  PubMed  Google Scholar 

  32. Mironov A (2005) Cranial dural arteriovenous fistulas: clinical findings and radiologic diagnostics. Klin Neuroradiol 15: 32–39

    Article  Google Scholar 

  33. Molyneux A, Kerr R, Stratton I et al. (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  34. Nosher JL, Chung J, Brevetti LS et al. (2006) Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics 26: 1687–1704

    Article  PubMed  Google Scholar 

  35. Paschalidis M, Theiss W, Kölling K et al. (2006) Randomised comparison of manual compression repair versus ultrasound guided compression repair of postcatheterisation femoral pseudoaneurysms. Heart 92: 251–252

    Article  PubMed  CAS  Google Scholar 

  36. Radeleff B.A., S. Satzl, M. Eiers et al. (2007) Klinische 3-Jahres-Ergebnisse nach Uterusmyom-Embolisation. Fortschr Röntgenstr 179: 593–600

    Article  CAS  Google Scholar 

  37. Ramina R, Maniglia JJ, Fernandes YB et al. (2004) Jugular foramen tumors: diagnosis and treatment. Neurosurg Focus 17: E5

    Article  PubMed  Google Scholar 

  38. Rautio R, Haapanen A (2007) Transcatheter embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer. Cardiovasc Intervent Radiol 30: 300–303

    Article  PubMed  Google Scholar 

  39. Salem R, Thurston KG (2006) Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol 17: 1251–1278

    PubMed  Google Scholar 

  40. Salem R, Thurston KG (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: Special topics. J Vasc Interv Radiol 17: 1425–1439

    PubMed  Google Scholar 

  41. Salem R, Thurston KG (2006) Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3: Comprehensive literature review and future direction. J Vasc Interv Radiol 17: 1571–1593

    Article  PubMed  Google Scholar 

  42. Schellhammer F, Heindel W, Haupt WF et al. (1998) Somatosensory evoked potentials: a simple neurophysiological monitoring technique in supra-aortal balloon test occlusions. Eur Radiol 8: 1586–1589

    Article  PubMed  CAS  Google Scholar 

  43. Schenker MP, Duszak R, Soulen MC et al. (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol 12: 1263–1271

    Article  PubMed  CAS  Google Scholar 

  44. Schwartz MJ, Smith EB, Trost DW et al. (2007) Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int 99: 881–886

    Article  PubMed  Google Scholar 

  45. Siablis D, Papathanassiou ZG, Karnabatidis D et al. (2006) Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: successful treatment with transcatheter arterial embolization. A case study and review of the literature. World J Gastroenterol 12: 4264–4266

    PubMed  Google Scholar 

  46. Stone PA, AbuRahma AF, Flaherty SK et al. (2006) Femoral pseudoaneurysms. Vasc Endovasc Surg 40: 109–117

    Article  Google Scholar 

  47. Swanson KL, Prakash UB, Stanson AW (1999) Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982–1997. Mayo Clin Proc 74: 671–680

    PubMed  CAS  Google Scholar 

  48. Tasar M, Yetiser S (2004) Glomus tumors: therapeutic role of selective embolization. J Craniofac Surg 15: 497–505

    Article  PubMed  Google Scholar 

  49. Tsang LL, Lee TY, Chen TY et al. (2002) Microcoils embolization of splenic artery pseudoaneurysm complicated with chronic pancreatitis. Hepatogastroenterology 49: 842–843

    PubMed  Google Scholar 

  50. Tulsyan N, Kashyap VS, Greenberg RK et al. (2007) The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 45: 276–283

    Article  PubMed  Google Scholar 

  51. Uhl M, Euringer W, Makowiec F et al. (2007) Portal vein embolization preparation for major hepatic resection: a new standard in liver surgery. Rofo 179: 31–37

    PubMed  CAS  Google Scholar 

  52. Van Rooij WJ, Sluzewski M, Slob MJ et al. (2005) Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. AJNR Am J Neuroradiol 26: 175–178

    Google Scholar 

  53. Varela M, Real MI, Burrel M et al. (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46:474–481

    Article  PubMed  CAS  Google Scholar 

  54. Wankmüller H, Ganschow U, Schneider A et al. (2006) Acute femoral artery thrombosis after thrombin injection of a pseudoaneurysm. Dtsch Med Wochenschr 131: 203–206

    Article  PubMed  Google Scholar 

  55. Watzinger F, Gössweiner S, Wagner A et al. (1997) Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports. J Craniomaxillofac Surg 25: 335–343

    PubMed  CAS  Google Scholar 

  56. Weerth A de, Buggisch P, Nicolas V et al. (1998) Pancreaticoduodenal artery aneurysm – a life-threatening cause of gastrointestinal hemorrhage: case report and review of the literature. Hepatogastroenterology 45: 1651–1654

    PubMed  Google Scholar 

  57. Werner JA, Eivazi B, Folz BJ et al. (2006) State of the art of classification, diagnostics and therapy for cervicofacial hemangiomas and vascular malformations. Laryngorhinootologie 85: 883–891

    Article  PubMed  CAS  Google Scholar 

  58. White AM, Spies JB (2006) Uterine fibroid embolization. Tech Vasc Interv Radiol 9: 2–6

    Article  PubMed  Google Scholar 

  59. Wiebers D, Whisnant JP, Huston J et al. (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:.103–110

    Google Scholar 

  60. Wingen M, Günther RW (2001) Transcatheter embolization of pulmonary arteriovenous fistulas. Rofo 173: 606–611

    PubMed  CAS  Google Scholar 

  61. Yalvac S, Kayikcioglu F, Boran N et al. (2002) Embolization of uterine artery in terminal stage cervical cancers. Cancer Invest 20:754–758

    Article  PubMed  Google Scholar 

  62. Yamashita Y, Harada M, Yamamoto H et al. (1994) Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome. Br J Radiol 67: 530–534

    PubMed  CAS  Google Scholar 

  63. Zangos S, Eichler K, Balzer JO et al. (2007) Large-sized hepotocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT). Eur Radiol 17: 553–563

    Article  PubMed  Google Scholar 

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  1. Klinik für Diagnostische und Interventionelle Radiologie, Gefäßzentrum Hannover, Diakoniekrankenhaus Henriettenstiftung, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Marienstrasse 72–90, 30171, Hannover, Deutschland

    P. Landwehr & G. Voshage

  2. Radiologie – Gefäßzentrum Karlsruhe, Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe, Deutschland

    S. Arnold & P. Reimer

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  1. P. Landwehr
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Landwehr, P., Arnold, S., Voshage, G. et al. Grundlagen der Embolisation und anderer verschließender Verfahren. Radiologe 48, 73–98 (2008). https://doi.org/10.1007/s00117-007-1597-2

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